Increased failure rates after the introduction of the TFNA proximal femoral nail for trochanteric fractures: implant related or learning curve effect?

Background and purpose — Trochanteric fractures are often treated using intramedullary fixation. In our institution, the TFN-Advanced Proximal Femoral Nailing System (TFNA) was introduced as replacement for the Gamma Trochanteric Nail (GTN3) for the treatment of these fractures as a result of a hospital-driven change of trauma implant supplier. We compared trochanteric fracture fixation failure rate between these 2 intramedullary nails. Patients and methods — All trochanteric fractures treated surgically from 2011 to 2019 were retrospectively reviewed for fixation failure. From 2016 only the TFNA was used. Fixation failure was defined as implant cut-out, implant breakage, non-union, malpositioning of the screw/blade requiring reoperation, new fracture around the nail, or miscellaneous. Propensity score matching was used to balance distribution of covariates and to compare failure rates between TFNA and GTN3 groups. Learning curve analyseswere performed. Results — After exclusion, 797 GTN3s (779 patients) and 542 (536 patients) TFNAs were available for analysis. A higher risk of fixation failure was found in the TFNA group (14%) compared with the GTN3 group (7.0%) (hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.2–3.5). This was mainly attributed to a higher risk of cut-out (HR 2.2; CI 0.9–5.7), malpositioning (HR 4.7; CI 0.7–34), and new fracturearound the nail (HR 4.0; CI 1.0–16). Learning curve analyses indicated no clear learning curve effect. Interpretation — Failure of fixation increased after a switch from the GTN3 to the TFNA proximal femoral nail for the treatment of trochanteric fractures. Cut-out and malpositioning of the calcar screw or blade appeared to be the most dominant failure mechanisms. Modifications in implant design may have played a role in this increased risk of failure of fixation. In our institution a new implant device was introduced without solid clinical evidence behind it. This study may help to underline the need for medical doctors with acritical and scientific background to be involved in implant choices.

Outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable intertrochanteric femoral fractures in elderly patients.

Objective: To know about the outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable inter-trochanteric femoral fractures in elderly patients. Study Design: Descriptive study. Setting: Maqsood Medical Complex, Pak Medical Centre and Habib Medical Complex. Period: August 2016 to July 2018. Material & Methods: Total of 70 patients with unstable inter-trochanteric fracture and age above 60 years were included in the study. The fracture was fixed with dynamic hip screw and trochanteric stabilizing plate. Patients were evaluated every month after surgery for healing of fracture. Final functional outcome was measured at 6 months after surgery with Harris Hip Score. Results: Out of 70 patients 44 (63%) were females and 26 (37%) were males. Mean age was 74.34(SD + 08.31) years with range of 60 to 87 years. Mean Harris Hip Score at 6 months was 85% with standard deviation of± 4.Ten (14%) patients had excellent, 40 (58%) patients had good, 16 (23%) patients fair and 4 (5%) patients poor functional outcome. Conclusion: Excellent and good functional outcome can be achieved in unstable inter-trochanteric fractures fixed with dynamic hip screw and trochanteric stabilizing plate in majority of patients.

A PROSPECTIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF PERTROCHANTERIC FEMUR FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL ANTI ROTATION II ( PFN A2)

BACKGROUND: Femoral Inter-Trochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. OBJECTIVES: This study aimed to study the functional and radiological outcomes of operative management of intertrochanteric fracture treated by PFN-A2. MATERIAL & METHODS: A prospective study of 20 cases of intertrochanteric femur fracture treated by PFN-A2, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. RESULT: Functional result according to Modified Harris Hip score was found to be excellent in 11(55%) patients, good in 5(25%) patients, fair in 3(15%) patients & poor in 1(5%) patients. poor outcome occurs due to development of complications. CONCLUSION : PFN A2 has the advantage of minimal incision, shorter operative time, rapid rehabilitation, lower medical complications among other options.

INTERTROCHANTERIC FRACTURES FIXATION WITH PFN AND PFNA2 PROXIMAL FEMORAL NAILS- PROSPECTIVE RANDOMISED COMPARATIVE STUDY ASSESSING FUNCTIONAL OUTCOME

Introduction: Trochanteric fractures are among the most common injuries which are usually resulting from minimal to moderate physical trauma to areas of bone signicantly weakened by osteoporosis. The greatest problems for the orthopaedic surgeon to treating the unstable trochanteric fracture and the complications (implant failure, varus collapse, non-union) occur from xation that result of instability. The implants have evolved from extramedullary implants like dynamic hip screw to the intramedullary types of PFNA2 nail. 50 patients were included in our study from July 2019 to July 2021. 25 patient Material And Methods : s were treated with PFNA2 (Group I) and 25 patients with PFN (Group II) Nails. Mean blood loss during surgery was 153.8±10.92 Results : & 201.6±38.48 in group I & group II respectively and the mean duration of surgery in group I and group II was 65.24+6.57 min and 85.44 + 11.08 min respectively. Conclusion : We concluded that use of helical blade PFN is certainly better in 31A2.2 and 31A3.3 type of fracture than screw PFN.

GREATER TROCHANTERIC FRACTURE IN STABLE INTERTROCHENTRIC FRACTURE

Background : stable intertrochentric femur with displaced greater trochanter is uncommon fracture pattern . intertrochentric femur fractures are associated with high morbidity and mortality , affecting both genders ,with different complexity Case report in our case report we have 75 years old male patient with history of fall sustained intertrochentric femur fracture with displaced greater trochenter treated with fixation of both fracture element Using dynamic hip screw (DHS) with trochentric stabilizing plate (TSP) in addition to tension band fixing the greater trochenter Discussion : different pattern of intertrochentric femur fracture require thorough planing for optimum management .intertrochentric femur fracture with displaced greater trochanter need further research to identify the best management option specially regard of functionality.

Physiotherapeutic proceedings with patient after petrochanteric fracture

Introduction: The elderly are often affected by hip fractures. A trochanteric fracture is defined as when the fracture fissure is between the capsule and 3 cm below the lesser trochanter. The most common cause of these fractures is osteoporosis in the elderly. Treatment of a trochanteric fracture may be operative or conservative. The aim of this study was to define a plan of physiotherapeutic treatment in a patient after fixation of a trochanteric fracture with an intramedullary nail.Materials and methods: The work was written based on the medical history of a patient with a trochanteric fracture. The entire treatment procedure was carried out at the Department of Orthopedics, Traumatology and Oncology of the Musculoskeletal System, located at Unii Lubelskiej 1 in Szczecin.Results: Rehabilitation is an indispensable element in the treatment process of patients after a trochanteric fracture. It is implemented already from 1 day after the surgery in order to activate the patient as soon as possible. Such a procedure is to ensure faster activation of the patient and to avoid adverse changes resulting from too long immobilization.Conclusion: Rehabilitation is an indispensable element in the treatment of patients after a trochanteric fracture. Early patient activation reduces the risk of postoperative complications.

A Novel Method of Management of Unstable Trochanteric Fractures - A Retrospective Study in a Tertiary Care Hospital, Mysore

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw